Written by Jodi Grahl, Director of Gynecology, General Surgery and Pacemaker Programs Day 5, and it is pouring rain in Santa Cruz. We arrived from Cochabamba yesterday afternoon - it took the plane a few tries before we could land due to the dense fog over the city. After evaluating three patients, we dashed across town to the Incor Hospital where they were waiting for Marian's presentation on Troubleshooting in ICDs. Carlos and Susan arrived drenched from a wave of water splashed into their taxi's window, and everyone could have used a dry pair of socks, but it was already 8:30 in the evening and the show must go on! It was a wonderful reception, with lots of questions from experienced surgeons and residents alike.

It continued to pour all night - a strange combination of a locally-infamous "Sur" storm, consisting of bitter winds that blow up from Antarctica, with a tropical storm. I pulled out my down jacket for this morning's trip to the hospital, which, by the way, is delayed by the lack of taxis. No one is willing to walk anywhere in the blowing rain.

Luis Mercado, MD, Marian Holland, MD, Susan Klosterman, and Cathy Aschbacher, RN reviewing their patient who received an implant the day before.

It has been a tough week so far - unbelievable large hearts, ravaged by Chagas, in tiny fragile bodies. Implants that should take two hours stretching to five. We are working on coming up with a word for the one full meal we have averaged per day - linner? dunch? One night the team made it back to the hotel lobby at 10pm and couldn't go further - fortunately I was able to order some quick pizzas and scrounge up plates and napkins from the kitchen before the team stumbled off to bed.

Yes we are tired. But at the same time, we know we are needed here, and there is no better feeling than that.

Our taxi is finally here. Please keep us in your prayers as we draw on our last reserves to help a few more patients today.

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